What have you done without a Dr. order?

Nurses General Nursing Nursing Q/A

So what things have you done withOUT a doctor's order, for a patient?? I don't think I'm too bad, I'll send off a stool for c-diff if a patient has diarrhea, order a stat ABG for a pt in resp distress before calling the doc as well as an x-ray and will order a blood test or something if I think its necessary. I don't think I have ever given a med though, without an order (well, I have been known to give out a cepacol lozenge, but that's about it.) But I do know nurses that give out a maalox or robitussin without calling the doc. So I just wanna know, what kind of things do you feel comfortable doing without an order?

I'm probably too new of a nurse to answer this question because I've never been put in this type of situation, but I know I wouldn't hesitate when it comes to placing a patient in respiratory distress on oxygen. I also don't see the harm in collecting a urine or stool sample without an order, but I'd wait for the order before I send it to the lab.

Specializes in OR.

I had a patient once that had about 5-6 BM's during the shift. I decided to be prudent and call the GI doc and ask for a c-diff order, and his response was "hmmm, well what did the BM smell like?? If it smells bad, then order a c-diff." honestly, I never called him again for a c-diff order.

What kind of setting do you work in?

I could see this being an issue if you work somewhere where the doctors are slow to respond.

I work day shift in a teaching hospital, so getting at least a verbal or phone order is easy.

The fact that you are writing about this issue suggests you are not fully comfortable with this practice?

giving o2 to a patient who desatted ..is part of our job, isnt it?

Of course it is! However, in theory, one must request an MD order before doing so. Deep breath, deep breath.........

Of course it is! However, in theory, one must request an MD order before doing so. Deep breath, deep breath.........

This is why it's important to know your facility's P&Ps. I've never worked anywhere that there wasn't a written policy that RNs could initiate O2 at up to 2 lpm as a nursing action (without a physician's order) in a situation like that, and then let the physician know about the situation.

well first of all, we should be anonymous on here, and any other internet site, if you're concerned about privacy.

Anonymity goes both ways on a site like this. None of us ever know, when we post here, who is reading our posts and whether we may have inadvertently disclosed enough information at some point to enable someone who knows us to identify who we are ...

Specializes in LTC Rehab Med/Surg.
giving o2 to a patient who desatted ..is part of our job, isnt it?

02 is the only thing I'll apply/give without an order. I can't defend my license against ordering tests, giving meds without an order.

If I do apply 02, I'm on the phone ASAP getting an order for that 02.

Specializes in Trauma/Tele/Surgery/SICU.

I am suprised and frankly kind of jealous at some of the responses in this thread. At my facility we are responsible for inputting all orders, take multiple verbal orders per shift and are often waiting on doctors who are very slow to call back......we have had patients leave AMA after waiting upwards of 12 hours for orders for diets, pain meds, etc. It is ridiculous and an environment where "cowboy" RN's thrive. I WISH we were not allowed to take verbals except in emergencies and that the docs had to enter their own orders. I also wish we got quick call backs. Noahsmama I would love to work in facilities such as the ones you have described!!!!

Specializes in ER, Trauma.

Ultimately, when you come right down to it, you can always defend doing what's best for the patient. Working in ER's, for example; I'd much rather face a jury for giving a minor good medical care without parental consent, than face a jury for letting a minor suffer or deteriorate for lack of parental consent. I might lose my job, my license, the $67 I have in the bank, but I wouldn't lose 1 minute of sleep. Somehow the human race survived a long time without doctors orders, so they just might not be the hallowed message from the Gods we're told.

Somehow the human race survived a long time without doctors orders, so they just might not be the hallowed message from the Gods we're told.

I don't think anyone here has suggested that physician orders are "hallowed messages from the Gods," and I've never heard that suggested anywhere else, either. But they are legal requirements. Like driver's licenses -- I'm sure that you, and everyone else here, are just as competent as I am to drive a car safely -- but, if we do it without a valid driver's license, we're breaking the law and there will be legal consequences if we get caught. Not a chance I'm interested in taking.

Specializes in Psych/CD/Medical/Emp Hlth/Staff ED.

What is it that we think is going to happen exactly by discussing this?

Specializes in ER, ICU.

I just stick to protocol. Need my license.

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